https://doi.org/10.4081/monaldi.2024.2815
Proportion of sleep-related breathing disorders and their association with echocardiographic parameters in stable patients with chronic obstructive pulmonary disease: a cross-sectional observational exploratory study
Submitted: October 28, 2023
Accepted: April 30, 2024
Published: July 24, 2024
Accepted: April 30, 2024
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality throughout the world. The coexistence of COPD and obstructive sleep apnea (OSA) (i.e., overlap syndrome) has been reported in several studies. Both disorders independently increase the risk of cardiovascular complications. Hence, there is a theoretical possibility that cardiovascular parameters may be worse in patients with overlap syndrome compared to those with only COPD. However, this has been sparsely assessed in the literature. This study aimed to compare the clinical characteristics, echocardiography, and sleep parameters amongst COPD patients with and without sleep-related breathing disorders (SRBD). This observational, cross-sectional study included 30 patients with stable COPD. All participants underwent a detailed clinical evaluation, followed by level 1 polysomnography (PSG). Each participant underwent echocardiographic evaluation to estimate mean pulmonary artery pressure from right ventricular systolic pressure (RVSP). Based on their PSG findings, participants were classified into non-SRBD and SRBD groups. Both groups were further compared with respect to clinical characteristics, echocardiographic, and PSG parameters. We found that most of the participants (93.3%) were male, and the mean age of the study population was 56±8.2 years. The only SRBD identified in this study was OSA, which was observed in 80% of participants. In this group, OSA was not associated with obesity. Systemic hypertension (50%) was the most common comorbidity, followed by diabetes mellitus (26.67%), but both were not significantly different between the groups. The mean RVSP was significantly higher amongst OSA patients than non-OSA patients (41.25±14.98 versus 30.83±5.84, respectively; p=0.01). OSA was seen in 80% of participants with stable COPD, even in the absence of obesity. The presence of OSA was associated with a higher RVSP in this patient group.
World Health Organization. The top 10 causes of death. 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Accessed on: 10/10/23.
Curkendall SM, DeLuise C, Jones JK, et al. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients. Ann Epidemiol 2006;16:63-70.
DOI: https://doi.org/10.1016/j.annepidem.2005.04.008
Pela G, Li Calzi M, Pinelli S, et al. Left ventricular structure and remodeling in patients with COPD. Int J Chron Obstruct Pulmon Dis 2016;11:1015-22.
DOI: https://doi.org/10.2147/COPD.S102831
Yan L, Zhao Z, Zhao Q, et al. The clinical characteristics of patients with pulmonary hypertension combined with obstructive sleep apnoea. BMC Pulm Med 2021;21:378.
DOI: https://doi.org/10.1186/s12890-021-01755-5
Medrek SK, Sharafkhaneh A, Spiegelman AM, et al. Admission for COPD exacerbation is associated with the clinical diagnosis of pulmonary hypertension: results from a retrospective longitudinal study of a veteran population. COPD 2017;14:484-9.
DOI: https://doi.org/10.1080/15412555.2017.1336209
American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.
Ryan S, Taylor CT, McNicholas WT. Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation 2005;112:2660-7.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.556746
Ismail K, Roberts K, Manning P, et al. OSA and pulmonary hypertension: time for a new look. Chest 2015;147:847-61.
DOI: https://doi.org/10.1378/chest.14-0614
Shehata Me A, El-Desoky ME, El-Razek Maaty A, et al. Pulmonary hypertension in obstructive sleep apnea hypopnea syndrome. Egypt J Chest Dis Tuberc 2013;62:459-65.
DOI: https://doi.org/10.1016/j.ejcdt.2013.03.004
Soler X, Gaio E, Powell FL, et al. High prevalence of obstructive sleep apnea in patients with moderate to severe chronic obstructive pulmonary disease. Ann Am Thorac Soc 2015;12:1219-25.
DOI: https://doi.org/10.1513/AnnalsATS.201407-336OC
Schreiber A, Cemmi F, Ambrosino N, et al. Prevalence and predictors of obstructive sleep apnea in patients with chronic obstructive pulmonary disease undergoing inpatient pulmonary rehabilitation. COPD 2018;15:265-70.
DOI: https://doi.org/10.1080/15412555.2018.1500533
Sharma B, Feinsilver S, Owens RL, et al. Obstructive airway disease and obstructive sleep apnea: effect of pulmonary function. Lung 2011;189:37-41.
DOI: https://doi.org/10.1007/s00408-010-9270-3
Mohammad OI, Elgazzar AG, Mahfouz SM, Elnaggar ME. Prevalence of obstructive sleep apnea among patients with chronic obstructive pulmonary disease. Egypt J Bronchol 2021;15:46.
DOI: https://doi.org/10.1186/s43168-021-00093-8
Naranjo M, Willes L, Prillaman BA, et al. Undiagnosed OSA may significantly affect outcomes in adults admitted for COPD in an inner-city hospital. Chest 2020;158:1198-207.
DOI: https://doi.org/10.1016/j.chest.2020.03.036
Zhang P, Chen B, Lou H, et al. Predictors and outcomes of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in China. BMC Pulm Med 2022;22:16.
DOI: https://doi.org/10.1186/s12890-021-01780-4
Sanders MH, Newman AB, Haggerty CL, et al. Sleep and sleep-disordered breathing in adults with predominantly mild obstructive airway disease. Am J Respir Crit Care Med 2003;167:7-14.
DOI: https://doi.org/10.1164/rccm.2203046
Flenley DC. Sleep in chronic obstructive lung disease. Clin Chest Med 1985;6:651-61.
DOI: https://doi.org/10.1016/S0272-5231(21)00402-0
Shawon MS, Perret JL, Senaratna CV, et al. Current evidence on prevalence and clinical outcomes of co-morbid obstructive sleep apnea and chronic obstructive pulmonary disease: a systematic review. Sleep Med Rev 2017;32:58-68.
DOI: https://doi.org/10.1016/j.smrv.2016.02.007
Weitzenblum E, Chaouat A, Kessler R, Canuet M. Overlap syndrome: obstructive sleep apnea in patients with chronic obstructive pulmonary disease. Proc Am Thorac Soc 2008;5:237-41.
DOI: https://doi.org/10.1513/pats.200706-077MG
Lavie P, Herer P, Peled R, et al. Mortality in sleep apnea patients: a multivariate analysis of risk factors. Sleep 1995;18:149-57.
DOI: https://doi.org/10.1093/sleep/18.3.149
Ganga HV, Nair SU, Puppala VK, Miller WL. Risk of new-onset atrial fibrillation in elderly patients with the overlap syndrome: a retrospective cohort study. J Geriatr Cardiol 2013;10:129-34.
Malhotra A, Schwartz AR, Schneider H, et al. Research priorities in pathophysiology for sleep-disordered breathing in patients with chronic obstructive pulmonary disease. An official American Thoracic Society research statement. Am J Respir Crit Care Med 2018;197:289-99.
DOI: https://doi.org/10.1164/rccm.201712-2510ST
Sharma SK, Katoch VM, Mohan A, et al. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014. Lung India 2015;32:422-34.
DOI: https://doi.org/10.4103/0970-2113.159677
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2019 report. 2019. Available from: https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf. Accessed on: 22/03/2019.
Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 2017;13:479-504.
DOI: https://doi.org/10.5664/jcsm.6506
Berry RB, Albertario CL, Harding SM, et al. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Version 2.5. Darien, IL: American Academy of Sleep Medicine; 2018.
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39 e14.
DOI: https://doi.org/10.1016/j.echo.2014.10.003
Enson Y, Giuntini C, Lewis ML, et al. The influence of hydrogen ion concentration and hypoxia on the pulmonary circulation. J Clin Invest 1964;43:1146-62.
DOI: https://doi.org/10.1172/JCI104999
Bergofsky EH, Haas F, Porcelli R. Determination of the sensitive vascular sites from which hypoxia and hypercapnia elicit rises in pulmonary arterial pressure. Fed Proc 1968;27:1420-5.
Parasuraman S, Walker S, Loudon BL, et al. Assessment of pulmonary artery pressure by echocardiography - a comprehensive review. Int J Cardiol Heart Vasc 2016;12:45-51.
DOI: https://doi.org/10.1016/j.ijcha.2016.05.011
Strange G, Playford D, Stewart S, et al. Pulmonary hypertension: prevalence and mortality in the Armadale echocardiography cohort. Heart 2012;98:1805-11.
DOI: https://doi.org/10.1136/heartjnl-2012-301992
Machado MCL, Vollmer WM, Togeiro SM, et al. CPAP and survival in moderate-to-severe obstructive sleep apnoea syndrome and hypoxaemic COPD. Eur Respir J 2010;35:132-7.
DOI: https://doi.org/10.1183/09031936.00192008
Venkateswaran S, Tee A. Overlap syndrome between chronic obstructive pulmonary disease and obstructive sleep apnoea in a Southeast Asian teaching hospital. Singapore Med J 2014;55:488-92.
DOI: https://doi.org/10.11622/smedj.2014117
Mehta V, Vasu TS, Phillips B, Chung F. Obstructive sleep apnea and oxygen therapy: a systematic review of the literature and meta-analysis. J Clin Sleep Med 2013;9:271-9.
DOI: https://doi.org/10.5664/jcsm.2500
Steveling EH, Clarenbach CF, Miedinger D, et al. Predictors of the overlap syndrome and its association with comorbidities in patients with chronic obstructive pulmonary disease. Respiration 2014;88:451-7.
DOI: https://doi.org/10.1159/000368615
Shamim-Uzzaman Q, Singh S, Chowdhuri S. Hypopnea definitions, determinants and dilemmas: a focused review. Sleep Sci Pract 2018;2:7.
DOI: https://doi.org/10.1186/s41606-018-0023-1
Rosen IM, Kirsch DB, Chervin RD, et al. Clinical use of a home sleep apnea test: an American Academy of Sleep Medicine position statement. J Clin Sleep Med 2017;13:1205-7.
DOI: https://doi.org/10.5664/jcsm.6774
Ciftci B, Ciftci TU, Guven SF. Polisomnografía de parte de la noche y polisomnografía de toda la noche: comparación entre la primera y la segunda partes de la noche [Split-night versus full-night polysomnography: comparison of the first and second parts of the night]. Arch Bronconeumol 200;44:3-7. [Article in Spanish].
DOI: https://doi.org/10.1157/13114650
Greenberg-Dotan S, Reuveni H, Tal A, et al. Increased prevalence of obstructive lung disease in patients with obstructive sleep apnea. Sleep Breath 2014;18:69-75.
DOI: https://doi.org/10.1007/s11325-013-0850-3
Sun WL, Wang JL, Jia GH, et al. Impact of obstructive sleep apnea on pulmonary hypertension in patients with chronic obstructive pulmonary disease. Chin Med J (Engl) 2019;132:1272-82.
DOI: https://doi.org/10.1097/CM9.0000000000000247
Tan WC, Sin DD, Bourbeau J, et al. Characteristics of COPD in never-smokers and ever-smokers in the general population: results from the CanCOLD study. Thorax 2015;70:822-9.
DOI: https://doi.org/10.1136/thoraxjnl-2015-206938
He BT, Lu G, Xiao SC, et al. Coexistence of OSA may compensate for sleep related reduction in neural respiratory drive in patients with COPD. Thorax 2017;72:256-62.
DOI: https://doi.org/10.1136/thoraxjnl-2016-208467
Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of sleep apnea. Physiol Rev 2010;90:47-112.
DOI: https://doi.org/10.1152/physrev.00043.2008
Karachaliou F, Kostikas K, Pastaka C, et al. Prevalence of sleep-related symptoms in a primary care population - their relation to asthma and COPD. Prim Care Respir J 2007;16:222-8.
DOI: https://doi.org/10.3132/pcrj.2007.00045
Chang CH, Chuang LP, Lin SW, Lee CS, Tsai YH, Wei YF, et al. Factors responsible for poor sleep quality in patients with chronic obstructive pulmonary disease. BMC Pulm Med 2016;16:118.
DOI: https://doi.org/10.1186/s12890-016-0281-6
McNicholas WT. Chronic obstructive pulmonary disease and obstructive sleep apnea: overlaps in pathophysiology, systemic inflammation, and cardiovascular disease. Am J Respir Crit Care Med 2009;180:692-700.
DOI: https://doi.org/10.1164/rccm.200903-0347PP
Ethics Approval
The present study was approved by institute’s ethical committee vide letter no. AIIMS/IEC/20/528.How to Cite
Prakash, Vipul, Arjun Kumar, Lokesh Kumar Saini, Barun Kumar, Girish Sindhwani, Prakhar Sharma, Ruchi Dua, Ravi Gupta, and Mayank Mishra. 2024. “Proportion of Sleep-Related Breathing Disorders and Their Association With Echocardiographic Parameters in Stable Patients With Chronic Obstructive Pulmonary Disease: A Cross-Sectional Observational Exploratory Study”. Monaldi Archives for Chest Disease, July. https://doi.org/10.4081/monaldi.2024.2815.
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